Excellent summary of a difficult (as in different recommendations over time as you showed) topic. You also point out the problem with the observational studies which informed some of the recommendations over time: when judging whether or not alcohol is protective or harmful, and you look at consumption volume in a large group of people to make your determinations, there is an inherent complexity not adequately addressed. As you pointed out, there are environmental toxins, but there are also all the other lifestyle issues (sleep, overall nutrition, type of diet consumed, relationships, etc) as well as genetics. To have made a broad stroke recommendation in favor of alcohol moderation on the observational component alone is,(especially in retrospect) rather foolish. Now, if you want to track a population to determine if moderate use of alcohol is good: track ALL of the parameters you can find, and do so prospectively, not in a retrospective ("I remember what I drank last week") manner. It can (and probably should) be done to clearly identify multiple issues of health in order to educate the public as well as their physicians as to what is real and what is speculation. I never over-used alcohol, but I absolutely consumed it several days a week (mostly wine with dinner). But for all the negative reasons you mentioned (especially in dealing with and reversing Type 2 Diabetes and Cancer), my consumption is limited and very purposeful. Once again, I wish your writing was available in medical school!!!
For me one question is why methanol kills and ethanol is damaging but not quickly. Perhaps it is an adaptation to grain in diet… and something I read stated that oranges were roughly 0.5% ethanol.
Ethanol is metabolized by the liver into acetate and acetaldehyde, both rapidly cleared by the body. Methanol on the other hand, is metabolized by the liver into formaldehyde and formate which are cleared slowly. The latter inhibits important metabolic pathways at the mitochondrial level which leads to acute metabolic acidosis and optic nerve damage.
Ironically enough, drinking ethanol after acute methanol ingestion can buy time by delaying methanol metabolism (ethanol has a higher affinity for alcohol dehydrogenase enzyme) preventing methanol toxic metabolites from accumulating until a more permanent treatment (usually dialysis) can be implemented.
Excellent summary of a difficult (as in different recommendations over time as you showed) topic. You also point out the problem with the observational studies which informed some of the recommendations over time: when judging whether or not alcohol is protective or harmful, and you look at consumption volume in a large group of people to make your determinations, there is an inherent complexity not adequately addressed. As you pointed out, there are environmental toxins, but there are also all the other lifestyle issues (sleep, overall nutrition, type of diet consumed, relationships, etc) as well as genetics. To have made a broad stroke recommendation in favor of alcohol moderation on the observational component alone is,(especially in retrospect) rather foolish. Now, if you want to track a population to determine if moderate use of alcohol is good: track ALL of the parameters you can find, and do so prospectively, not in a retrospective ("I remember what I drank last week") manner. It can (and probably should) be done to clearly identify multiple issues of health in order to educate the public as well as their physicians as to what is real and what is speculation. I never over-used alcohol, but I absolutely consumed it several days a week (mostly wine with dinner). But for all the negative reasons you mentioned (especially in dealing with and reversing Type 2 Diabetes and Cancer), my consumption is limited and very purposeful. Once again, I wish your writing was available in medical school!!!
Thank you very much for your gracious comment.
For me one question is why methanol kills and ethanol is damaging but not quickly. Perhaps it is an adaptation to grain in diet… and something I read stated that oranges were roughly 0.5% ethanol.
Ethanol is metabolized by the liver into acetate and acetaldehyde, both rapidly cleared by the body. Methanol on the other hand, is metabolized by the liver into formaldehyde and formate which are cleared slowly. The latter inhibits important metabolic pathways at the mitochondrial level which leads to acute metabolic acidosis and optic nerve damage.
Ironically enough, drinking ethanol after acute methanol ingestion can buy time by delaying methanol metabolism (ethanol has a higher affinity for alcohol dehydrogenase enzyme) preventing methanol toxic metabolites from accumulating until a more permanent treatment (usually dialysis) can be implemented.